Journal of Applied Gerontology
http://jag.sagepub.com/
Positive Attitudes Toward Older People and Well-being Among
Chinese Community Older Adults
Luo Lu, Shu-Fang Kao and Ying-Hui Hsieh
Journal of Applied Gerontology 2010 29: 622 originally published online 1
September 2009
DOI: 10.1177/0733464809343289
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Article
Positive Attitudes
Toward Older People
and Well-being Among
Chinese Community
Older Adults
Journal of Applied Gerontology
29(5) 622­–639
© The Author(s) 2010
Reprints and permission: http://www.
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0733464809343289
http://jag.sagepub.com
Luo Lu1, Shu-Fang Kao2, and
Ying-Hui Hsieh3
Abstract
We aimed to explore older people’s attitudes toward aging and to further
examine associations of such attitudes with their well-being in a Chinese society—
Taiwan. Face-to-face interviews were conducted to collect data using structured
questionnaires from a random sample of community older people (N = 316). We
found that (a) older people possessed positive attitudes toward aging in general, but
there were some group attitudinal differences associated with education attainment
and urban residence; (b) older age, fewer social support, and less positive attitudes
toward aging were related to more depressive symptoms; (c) younger age, greater
social support, greater community participation, and more positive attitudes were
related to higher happiness. The associations of positive attitudes with well-being
were found after controlling for those of social support and community participation.
Keywords
attitudes toward older people, social support, community participation,
well-being
Manuscript received: December 22, 2008; final revision received and
accepted: June 24, 2009.
1
Department of Business Administration, National Taiwan University, Taiwan
Department of Applied Psychology, Hsuan Chuang University, Taiwan
3
Department of Human Development, Tzu Chi University, Taiwan
2
Corresponding Author:
Luo Lu, Department of Business Administration, National Taiwan University,
N0.1, Sec. 4, Roosevelt Road, Taipei 106, Taiwan, Republic of China
Email: luolu@ntu.edu.tw
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Lu et al.
Aging is a pressing problem for many countries in this century, especially for a
developing country such as Taiwan. In Taiwan, advance in medical science and
technology, successful promotion of health care, and material prosperity,
coupled with the gradual demise of Chinese family values and lifestyle, have
sent the birth rate in a steady decline but life expectancy in a steady increase.
Consequently, as early as in September 1993, Taiwan was officially an aging
society as the proportion of those aged above 65 had exceeded 7% of the country’s population (Lin, 2002). However, systematic research on aging topics in
Taiwan is still in its infancy and relies heavily on Western theories and
findings. Furthermore, most research efforts have been devoted to medical gerontology and other aging-related medical care topics, whereas psychosocial
issues of normative aging are generally overlooked. Although there has been
some research pointing out the buffering effects of social support for the
Chinese older people in Taiwan (e.g., Hu, 1992; Lu & Hsieh, 1997), older
people’s self-definition and perception of aging have largely been ignored so
far. Our purpose of this study therefore was to explore a basic issue in social
gerontology from the older people’s point of view: Can aging be a positive
experience? If yes, are positive attitudes toward aging beneficial for personal
well-being, over and beyond effects of known protectors such as social support
and social embeddedness?
Is it Possible to Experience Aging as a Positive Process?
As stated earlier, for many years, gerontological research was concerned nearly
exclusively with problems of aging and older age and has contributed to the problematization of older age and the negative image of the aging process. However,
work in social gerontology has endeavored to deconstruct prevailing negative
aging stereotypes, that is, ageism in the society (Polizzi & Millikin, 2002), to
further promote educational interventions aiming at fostering positive attitudes
toward older people (Funderburk, Damron-Rodriguez, Levy Storms, & Soloman,
2006) and the aging process (Harris & Dollinger, 2001).
Among older people, researchers have also recently found that the experience
of aging is neither uniform nor necessarily negative. As part of the Berlin Aging
Study, Freund and Smith (1999) collected spontaneous self-definition in a heterogeneous sample of 516 participants (aged 70-103). The content of the selfdefinition revealed that these older adults still view themselves as active and
present-oriented, and overall, there were more positive than negative selfevaluations. More important perhaps, positive emotional well-being was associated with naming more and richer self-defining domains. Another study found
that when defining “old,” older people focused less on appearance or body image,
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Journal of Applied Gerontology 29(5)
more on health status and psychological factors such as loss of autonomy (Logan,
Ward, & Spitze, 1992).
In Taiwan, social gerontological research on self-perception of older people
or normative aging experiences is very rare. Two notable exceptions are a large
scale survey of young, middle-aged and older adults (Lee, 1999), and a study of
older adults with medical conditions (Lu & Chang, 1998). Lee’s study (1999)
focused on the general impression of life in middle to late adulthood and found
that Taiwanese people tended to perceive old age rather negatively, including
losses in health, status, relationships, and work. Furthermore, more negative and
undesirable traits and behaviors were attributed to older people than to middleaged people. These findings largely corroborate other studies in Taiwan showing
that people of different age groups all possessed generally negative attitudes
toward older people (Lin, 1987, 1993; Lu & Kao, 2009). Apparently, ageism is
still prevalent in the Taiwanese society.
Although the above mentioned empirical results seem to depict a general negative image of the old age and older people held by a wide range of Taiwanese
people, a fine-grained analysis did reveal that some positive aspects of aging
were acknowledged both by the older people themselves (Lu & Kao, 2009) and
by members of other age groups (Lee, 1999; Lin, 1993). Specifically, positive
attitudes and traits pertaining to psychological and cognitive aspects of aging,
such as rich experiences, wisdom, and authoritative status, were attributed to
older persons in aforementioned studies.
What about older people’s own experience of aging then? Lu and Chang
(1998) argued that aging is not an inevitably negative experience even for those
with compromised health. They found that older age, male, living alone, and being
financially dependent were risk factors of worsened health, whereas female, living alone, and being financially dependent were risk factors of lowered life
satisfaction in a sample of community older adults (aged 65-90). Although participants in that study all had at least one chronic medical condition, authors
observed that they nonetheless maintained good functioning in daily activities,
perceived little interference of illnesses with their normal life, reported fairly
good psychological health and optimistic outlooks in life. Such more encouraging positive experiences with aging corroborate Lu and Kao’s (2009) most
recent finding that older people indeed possessed more positive attitudes regarding cognitive and psychological aspects of aging than nonold adults in Taiwan.
It needs to be noted though that the sample of older persons included in the study
was rather small (N = 30), as the researchers were aiming at a wide spectrum of
the general population.
Adopting a different research paradigm, a rare qualitative research reported 22
in-depth interviews with community older adults in Taiwan (Lu & Chen, 2002).
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Lu et al.
Researchers noted that many of their interviewees held positive attitudes toward
their family roles in later life. Such positive self-perceptions for old age was
rooted in the rich life experiences, in the belief that they can teach, guide, and
help their children and grandchildren, and in the prevailing societal value of
respecting the old and ascribing authority to the old in family. From these rich
personal accounts of aging in the family, researchers concluded that given adequate health and financial assurance, Taiwanese older people generally held positive attitudes toward the impending aging and were able to adapt to the family
role transition with optimism.
Synthesizing these strands of research, we argue that aging can be experienced positively in a Chinese culture. At the society level, the prevailing social
value of filial piety and social norm of respecting the old in a Chinese society
help to strengthen status and prestige of older people both in and beyond the family domain (Lu & Chen, 2002). At the individual level, the possibility of maintaining a positive outlook for the old age and experiencing aging positively is
supported by a theoretical perspective emphasizing life course development
(Erickson, 1982). As one negotiates with specific developmental tasks through
the course of life, the process of aging should not necessarily be detrimental to
well-being; instead there even exists possibilities for positive change and personal growth. We thus hypothesize
Hypothesis 1: Older people in Taiwan would possess positive attitudes
toward aging.
What Are Important Social and Personal
Resources for a Successful Aging?
To achieve a successful aging, personal and social resources need to be mobilized. One purpose of the present study was to examine the incremental value of
positive attitudes toward aging over and beyond some known protectors. Social
support is one such known protector. Indeed, social epidemiological studies
focusing on older people have clearly pointed out that diseases and illnesses are
accounting for less and less variance in mortality, whereas psychosocial factors
can to some extent increase an individual’s resistance to pathological agents or
minimize their adverse effects on health and well-being (Cassel, 1976; Hanson,
Isacsson, Janson, & Lindell, 1989; Kasl & Berkman, 1981). Social support is one
such protective psychosocial factor. Research in this area has already accumulated
a large body of empirical evidence and a wide variety of theoretical formulations
such as stress-resources models (Hobfoll, 1989; Holahan & Moos, 1986), the
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Journal of Applied Gerontology 29(5)
convoy model (Kahn & Antonucci, 1980), and the support-efficacy model
(Antonucci & Jackson, 1987).
Focusing on older people, empirical evidence has generally supported the
beneficial effects of social support and social integration on health and wellbeing in the West and in Taiwan. For instance, Curtrona, Russell, and Rose (1986)
found in a longitudinal study that social support could predict physical health and
buffer the impact of life stress on mental health for older people living in the
community. In another community study, Coe, Wolinsky, Miller, and Prendergast (1984) found that social integration or network-embeddedness was related to
health of older people.
One Taiwanese community study has also found that social support had both
direct protective effects on physical and mental health, and mediating effects
linking perceived control to health (Lu & Hsieh, 1997). In another Taiwanese
study, social support had incremental value in predicting self-reported health and
life satisfaction, after controlling for age, illness, and level of daily functioning
(Lu & Chang, 1997). Earlier, Hu (1992) found that social support from the family
protected older people from mental illnesses. Huang (1992) too found that social
support was the most important predictor of life satisfaction, more powerful than
self-reports of health. Thus social support and social integration (or community
participation) as social resources have shown unequivocal benefits for positive
aging, that is, adjustment in the old age.
Personal resources such as personality, coping, values, and attitudes are also
theorized as important protectors against stress (Holahan & Moos, 1986). For
instance, Western studies have found that perceived control was positively related
to perceived health and negatively related to morbidity, rate of hospitalization,
and mortality (Menec & Chipperfield, 1997; Rodin & Timko, 1992). In Taiwanese
studies, researchers have also found that a greater sense of control was associated
with lower rates of mental health symptoms for community older people. Furthermore, perceived control was also associated with better self-reported physical health through generating a higher level of social support (Lu & Hsieh, 1997).
However, potential contributions of values and attitudes to well-being, especially
those concerning older people’s own perception and attitudes toward aging, have
received little research attention in Chinese societies including Taiwan. Several
recent Western studies though have noted the benefits of positive self-perception
for older people. For instance, Logan et al. (1992) found that positive aging perception was associated with well-being for older adults. Moor, Zimprich, Schmitt,
and Kliegel (2006) too found that positive aging self-concept was related to subjective health for older people. Levy, Slade, Kunkel, and Kasl (2002) reported
that positive perceptions of aging could even prolong life for 7.5 years for
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Lu et al.
participants in the Ohio Longitudinal Study of Aging and Retirement (OLSAR).
Unfortunately, there has been very scarce research looking at positive attitudes
toward aging as a personal resource for successful aging in a Chinese society.
One notable exception is a recent study looking at university students attitudes
toward older people in Mainland China (Tan, Zhang, & Fan, 2004). These authors
found that students’ attitudes were in the positive and neutral ranges and that
older males were perceived more favorably than older females. Such attitudes
tending toward the positive side were explained in the Chinese cultural tradition
of respecting the old, especially older males. Although neither this recent study
nor an earlier one looking at positive attitudes toward aging in Mainland China
(Levy & Langer, 1994) went further to explore the potential values of such positive attitudes for well-being, they both set up examples of successful aging in a
Chinese society.
Taking another angle, our earlier anthropological field work with Taiwanese
older people gave us the impression that those who maintained a positive outlook
for old age were those who continued to be active in their communities and
enjoyed a higher quality of life (Lu & Chen, 2002). This finding suggests that
active participation in community life may be another psychosocial protector for
well-being of Chinese older people. Furthermore, community participation could
be an expression of one’s usefulness in passing on life experiences and wisdom,
which is expected by others and perceived by older people themselves in Chinese
societies, as previous studies revealed. We thus hypothesize
Hypothesis 2: Positive attitudes toward aging would be associated with
well-being of older people in Taiwan, and this association would remain
even after controlling for social support and community participation.
Method
Samples and Procedures
We combined face-to-face interviews with structured questionnaires to collect
data from community-residing older people in Taiwan. Trained interviewers
(students of social work and psychology) conducted home visits to randomly
selected households with residing older persons aged above 60 years. According
to the earlier cited nationwide survey (Lee, 1999), Taiwanese people generally
regarded 60 as the defining age of being “old,” not the official criterion of 65.
To better represent this culture-specific psychological reality, we thus included
people from 60 years of age onward in the present study. Specifically, we
interviewed only people above the age of 60, and only one participant was
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Journal of Applied Gerontology 29(5)
interviewed in each household surveyed. Interviews were conducted in one
northern county and one southern county of the country. The overall completion rate was 90%.
The sample (N = 316) consisted of 147 men and 156 women, with a mean age
of 69.65 years (SD = 8.11). About half (52.7%) of our participants had some
elementary school education, with an average formal education of 8.87 years
(SD = 3.45). Most of them (62.7%) lived with other family members, and in rural
areas (60.7%).
Instruments
Attitudes Toward Aging
The “Older People Scale” (OPS, Lu & Kao, 2009) is the first standardized scale
developed specifically for the Chinese people, assessing attitudes toward older
people in general. When responding to the same items, young and older adults
may base their opinions on different information. Specifically, older respondents
are more likely to draw information from their own aging experiences, thus scale
scores may reflect to some extent their attitudes toward aging itself. However,
OPS is more a measure of attitudes toward older people. Lu and Kao (2009) have
provided evidence of its reliability, validity of its four-factor structural model,
convergent validity with an existing Western scale (Aging Semantic Differential;
Polizzi & Millikin, 2002), and criterion validity in predicting intentions of interacting with older people in daily life. The 22-item brief version was used in this
study. With “In general, older people are . . .” as the stem, four aspects of attitudes were assessed: Appearance and physical characteristics (5 items, e.g.,
“Weak and illness-prone,” reversed score), Psychological and cognitive characteristics (7 items, e.g., “possessing problem-solving ability”), Interpersonal relations
and social participation (7 items, e.g., “disengaged from the society”), and Work
and economic safety (3 items, e.g., “financially poor,” reversed score). Each item
was rated on a 7-point scale (1 = strongly disagree, 7 = strongly agree). A higher
score indicated more positive attitudes toward aging. In the present study, internal consistency alphas were .82, .83, .84, and .74, respectively, for the four
subscales, and .93 for the aggregated scale.
Social Support
The 18-item Functional Social Support Scale was specifically developed for
an older population (Hanson et al., 1989), and adopted earlier for use with
Chinese community older people (Lu & Hsieh, 1997). The Chinese version has
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Lu et al.
demonstrated good reliability, construct validity, and criterion validity in predicting health and satisfaction of community older people (Lu & Chang, 1997;
Lu & Hsieh, 1997). Important facets of social support are assessed, including
material and tangible support (e.g., “Are there relatives or friends who can take
you to the doctor if you are ill?”), social participation (e.g., “Do you take part
in important activities?”), emotional support (e.g., “Will someone praise you
for what you do?”), and information support (e.g., “Are there relatives or
friends who you can consult for personal problems?”). Each item was checked
with a forced choice format (1 = Yes, 0 = No). Following the scoring procedure
suggested by the scale developers, a higher aggregated score indicated more
social support. In the present study, internal consistency alpha was .76 for the
aggregated scale.
Community Participation
Seven items were developed to assess community participation of older people.
Aspects of family involvement (e.g., “helping with home maintenance”), community activities (e.g., “unpaid voluntary work”), educational activities (e.g., “taking
classes”), and work involvement (e.g., “holding a paid job”) were covered, and
respondents checked with a forced choice format (1 = Yes, 0 = No). Exploratory
factor analysis revealed that only one factor (Eigen value = 5.73) could be
extracted accounting for 59% of the total variance. All seven items loaded on this
single factor ranging from .50 to .75. Thus an aggregated score was used to indicate
community participation by older people. In the present study, internal consistency
alpha was .73 for the scale.
Well-Being
Two indicators were used to assess well-being of older people: depression and
happiness. Depression was measured by 11 items from the CES-D adopted for
the Chinese people (Cheng & Chien, 1984). Sample items are “Don’t feel like
eating, bad appetite,” and “Feeling sad and miserable.” Respondents rated each
item (symptom) on a 4-point scale (0 = never or very seldom, 3 = almost
always). A higher total score indicated a higher level of depressive symptoms.
In the present study, internal consistency alpha was .84 for the depression
scale. Happiness was measured by 4 items from the mini version of Chinese
Happiness Inventory (CHI; Lu, 2008a), developed and repeatedly tested for
use with the Chinese populations (Lu, 2005). A sample item is “I am satisfied
with most things in my life.” Respondents rated each item on a 4-point scale
(0 = strongly disagree, 3 = strongly agree). A higher total score indicated a
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630
Journal of Applied Gerontology 29(5)
higher level of happiness. In the present study, internal consistency alpha was
.83 for the happiness scale.
Results
To test Hypothesis 1, we computed item mean for the aggregated score on OPS
and those of its four subscales. All five mean scores were above the mid-point of
4 on the 1-7 scale, in the positive ranges. We further tested the significance of
these mean scale scores from 4 using one-sample t test, and found all the differences were statistically significant. These mean scores were: Total scale: 4.74
(SD = 1.09, t = 11.54, df = 284, p < .001); Appearance and physical characteristics: 4.61 (SD = 1.40, t = 7.64, df = 306, p < .001); Psychological and cognitive
characteristics: 4.81 (SD = 1.18, t = 11.79, df = 298, p < .001); Interpersonal relations and social participation: 4.72 (SD = 1.22, t = 10.15, df = 296, p < .001); and
Work and economic safety: 4.89 (SD = 1.34, t = 11.67, df = 309, p < .001). In fact,
all 22 individual item scores were statistically significantly from the midpoint of
4, with ts ranging from 4.06 (nagging) to 13.38 (frugal). Thus our Hypothesis 1
was supported.
We further examined group differences on attitudes across gender, age, education attainment, urban residence, and living arrangement. Table 1 presents the
results of one-way ANOVAs used to compare each of these subgroups. Because
scores for the four OPS subscales were significantly correlated with one another
(see Table 2), only the aggregate score of overall aging attitudes was used for
creating Table 1. Results showed that males were not different from females, the
“young old” (aged 60-74) were not different from the “old old” (aged 75 and
above), and those living with family were not different from those living alone in
their overall aging attitudes. However, education and urban residence had advantages of a more positive outlook for the old age. Specifically, those who were
educated above elementary school level and living in urban areas avowed more
overall positive attitudes toward aging.
Before testing Hypothesis 2, we computed Pearson correlations among main
research variables. Table 2 reports correlation results along with scale means and
standard deviations. Attitudes toward aging, social support, and community participation all significantly correlated with depression and happiness. All relations
were in the expected direction. To reiterate, the four aspects of aging attitudes
were very highly interrelated (rs ranged from .54 to .74). To avoid possible multicollinearity problem, we used only the aggregate score of overall aging attitudes
in further regression analysis.
As for demographic variables, age, education years, and urban residence correlated with aging attitudes, social support, community participation, depression,
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Lu et al.
Table 1. Attitudes Toward Aging: Group Differences
Overall attitudes toward aging
Male
Female
F (df)
Elementary school education
Above elementary school
F (df)
Urban residence
Rural residence
F (df)
Living with family
Living alone
F (df)
60-74 years of age
75 and above
F (df)
M
SD
104.17
104.64
0.03 (1, 282)
101.72
107.34
3.96* (1, 283)
107.90
101.99
4.09* (1, 279)
106.24
101.74
2.34 (1, 280)
105.88
100.47
2.89 (1, 282)
24.95
23.07
24.34
23.17
22.43
24.73
22.59
25.85
24.14
23.11
*p < .05.
and happiness. Living with family also correlated with social support, community
participation, and happiness. In addition, females reported greater community
participation than males.
We then conducted a series of hierarchical regression analyses to test our
Hypothesis 2. We compared two models for each indicator of well-being separately: depression and happiness. For Model 1, in the first step of regression, we
entered demographic variables of sex, age, education years, urban residence, and
living with family. Second, we entered social support and community participation. For Model 2, the first two steps were the same as in Model 1, at Step 3, we
entered overall attitudes toward aging.
The results reported in Table 3 show that age was consistently related to wellbeing: age had a positive relation with depression and a negative relation with
happiness. Social support had a negative relation with depression and a positive
relation with happiness. Community participation had a positive relation with
happiness, and a negative relation with depression. Having controlled for effects
of demographic variables, social support, and community participation, attitudes
toward aging still had a negative relation with depression and a positive relation
with happiness (Model 2s). Thus our Hypothesis 2 was supported. The combination of social support, community participation, and aging attitudes explained
21%-31% of variance on two indicators of well-being.
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632
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–0.06
–0.01
FAM
Total-AA
DEP
HAP
8.06
69.58
–0.25***
0.25***
–0.43***
–0.43***
–0.12*
–0.12*
–0.18**
–0.14*
–0.18**
–0.11
–0.20***
–0.16**
1.00
Age
3.45
8.87
0.20***
–0.13*
0.29***
0.28***
0.07
0.09
0.15**
0.19***
0.12*
0.06
0.38***
1.00
EDU
(yrs)
0.49
0.41
0.17*
–0.20**
0.19**
0.17*
0.00
0.09
0.11
0.18**
0.12*
0.15*
1.00
Urban
0.48
0.63
0.11*
–0.10
0.27***
0.15*
–0.07
0.07
0.11
0.14*
0.09
1.00
FAM
23.92
104.36
0.51***
–0.40***
0.38***
0.49***
0.75***
0.90***
0.90***
0.84***
1.00
TotalAA
6.99
23.05
0.46***
–0.38***
0.33***
0.41***
0.56***
0.63***
0.69***
1.00
AP
8.29
33.66
0.51***
–0.37***
0.42***
0.48***
0.54***
0.74***
1.00
PC
8.56
33.04
0.44***
–0.33***
0.37***
0.43***
0.63***
1.00
IS
4.02
14.66
0.32***
–0.39***
0.18**
0.24**
1.00
WE
3.29
13.38
0.54***
–0.50***
0.60***
1.00
SS
1.94
3.30
0.51***
–0.31***
1.00
CP
6.50
8.82
–0.49***
1.00
DEP
2.63
5.52
1.00
HAP
Note: AP = appearance and physical characteristics; PC = psychological and cognitive characteristics; IS = interpersonal relations and social participation;
WE = work and economic safety; Total-AA = attitudes toward aging (total score); SS = social support; CP = community participation; DEP = depression;
HAP = happiness; Sex: 0 = female, 1 = male; Urban: 0 = rural, 1 = urban; FAM: 1 = living with family, 0 = living alone
*p < .05. **p < .01. ***p < .001.
0.50
–0.02
–0.03
CP
SD
–0.14*
SS
0.49
–0.02
WE
Scale Mean
0.01
–0.02
IS
0.02
0.00
Urban
PC
0.24***
EDU (yrs)
0.00
0.16**
Age
AP
1.00
Sex
Sex
Variables
Table 2. Intercorrelations Among Main Variables
633
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DR2
b
Depression
(Model 1)
DR2
b
Depression
(Model 2)
DR2
b
Happiness
(Model 1)
DR2
b
Happiness
(Model 2)
Note: Standardized coefficients b and F are taken from the final equation. Sex: 0 = female, 1 = male; Urban residence: 0 = rural, 1 = urban; Living with
family: 1 = living with family, 0 = living alone
*p < .05. **p < .01. ***p < .001.
1
Sex
–.06
–.06
.01
–.03
Age
.23**
.22**
–.26**
–.20**
Education yrs.
.08
–.03
.02
.15*
Urban residence
–.11
–.13
.07
.06
Living with family
.09**
–.01
.09**
–.05
.10**
.02
.10**
.07
2
Social support
–.23**
–.20**
.38***
.31***
Community participation
.17***
–.48***
.17***
–.48***
.25***
.31***
.25***
.37***
Attitudes toward older people
.04*
–.20**
.06***
.29***
3
.26
.30
.35
.41
Total R2
Final F (df)
8.59*** (7, 167)
8.37*** (8, 165)
12.95*** (7, 169)
13.71*** (8, 165)
Step Predictors
Table 3. Hierarchical Regression Analysis Predicting Well-Being
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Discussion
The purpose of the present study was two-fold: to explore older people’s attitudes toward aging and to further examine whether positive attitudes were
associated with well-being in a Chinese society—Taiwan. It needs to be noted
that because we used an indigenous measure of attitudes toward older people
specifically developed for the Taiwanese, it would not be possible or appropriate to compare our results directly with those of Western studies when different
measures were used. However, we could compare the trend of our findings
against that revealed in existing Western studies. We found that in general
Taiwanese older people possessed positive attitudes toward aging, with mean
item scores above the theoretical midpoint of the rating scale. The little existing
Taiwanese research found the preponderance of positive attitudes toward aging
was confined to psychological and cognitive aspects, both viewed by older
people themselves (Lu & Kao, 2009), and by other age groups (Lee, 1999; Lin,
1993). In other words, old age along with its rich life experiences, wisdom, and
social prestige is to a certain extent represented in a positive light. However, we
found in the present study that from older people’s perspective, positive attitudes are not restricted to any one aspect of the aging process—they remain
optimistic for aging in physical, psychological, social, and financial aspects.
Our findings were consistent with Western studies showing overall positive
self-evaluations among older people (Freund & Smith, 1999) and generally
more favorable aging perceptions among older than younger people (Laditka,
Fischer, Laditka, & Segal, 2004).
In Taiwan, there has been no study looking at older people’s self-perception
or their attitudes toward aging. However, two recent studies did systematically
measure attitudes toward older people in Taiwan, using the same instrument as
we did in the present study. Comparing our item mean (4.74, SD = 1.09) with
those reported for the general population (4.23, SD = 0.74, N = 991; Lu & Kao,
2009), and with those reported for a sample of college students (4.46, SD = 0.77,
N = 391; Lu, 2008b), differences were statistically significant (t = 4.00, p < .001;
and t = 7.29, p < .001). These results confirmed that in the Taiwanese society,
older people viewed aging more positively than their younger counterparts. Studies in Taiwan have already shown that people of various age groups except older
persons themselves, all possessed some negative attitudes toward older people
(Lee, 1999; Lin, 1987, 1993). In this respect, ample Western studies have demonstrated the beneficial effects of education programs on dismantling negative
stereotypes and ageism (Funderburk et al., 2006; Harris & Dollinger, 2001); we
in Taiwan need to be more rigorous in promoting and implementing such programs at school and in the community.
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Lu et al.
In the present study, we have also found some further group differences
regarding attitudes toward aging. Generally, those who were better educated and
urban-dwelling had more positive attitudes toward aging. These results corroborate the notion that aging is not a uniform experience (Lu & Chang, 1998) and
some people fare better.
The advantages of education and status on well-being in the old age have been
well-documented in the literature. For instance, Butler and Lewis (1982, p. 11)
synthesized Western findings to conclude that “demographic data show conclusively that an increasing life expectancy follows in the wake of increasing income
and status.” In Taiwan, education and urban-dwelling are indicators of higher
social status and were found to have positive associations with health for older
people (Lin, 1983; Lu & Hsieh, 1997). Lu and Chang (1998) conducted a more
detailed analysis in a sample of community older adults with chronic medical
conditions. They found that those who were older, living alone, and financially
dependent were worse off in health and life satisfaction. Combining our current
findings with those reported in the literature, we can compile a demographic
profile of older persons who remain positive and are better adjusted to aging—
better education, urban-dwelling, and financially secure. The added value of our
present study is that we were the first to look at older people’s attitudes of aging,
which might serve as a precursor for their subsequent adaptation. More specifically, if we can identify older people who are at risk of negative outlook for aging,
such as those with minimal education, and living in rural areas, we can better
target our educational and care resources to prevent health hazards and depressed
emotional well-being.
We have found that attitudes toward aging were related to well-being, even
after controlling for age, social support, and community participation. Furthermore, these associations were found on both positive (happiness) and negative
(depression) indicators of well-being. Although positive attitudes were not the
strongest predictor of well-being, its contributions to depression and happiness
were largely independent from those of social support and community participation (comparing Model 1 and 2 in Table 3). Previous social gerontological
research has firmly established the protective effects of social resources, such as
social support and social integration or community participation (e.g., Antonucci
& Jackson, 1987; Hanson et al., 1989; Holahan & Moos, 1986; Kahn & Antonucci,
1980), and personal beliefs of control (Lu & Hsieh, 1997; Rodin & Timko, 1992).
We have extended the list of protectors to include positive attitudes, which is so
far largely overlooked in Chinese studies. Our results compliment Western findings of attitudinal benefits on longevity (Levy et al., 2002) and emotional wellbeing (Logon et al., 1992). Together, these results serve to underline the importance
of including personal resources such as positive attitudes and self-perceptions, as
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Journal of Applied Gerontology 29(5)
well as social resources such as social support and community participation in the
promotion of successful aging.
However, readers should still keep in mind that the present study has certain
limitations. First, it is unfortunate that the survey did not collect data on older
people’s health, and it is possible that the influence between health and aging
attitudes are bidirectional. Although health remains a viable alternative explanation for well-being, an earlier Taiwanese research found that social support was
the most important predictor of life satisfaction (a proxy to happiness), more
powerful than even self-reports of health (Huang, 1992). Another Taiwanese
study with older adults with medical conditions also found that social support had
comparable effects on mental symptoms (including depression) to impacts of illnesses (Lu & Chang, 1997). Thus controlling for social support in the present
study may have taken out some effects of health. However, this alternative hypothesis needs to be explicitly investigated in the future.
Second, the study design was cross-sectional, thus no causal conclusions are
legitimate. As stated above, the lack of explicit control for health poses a threat to
the causal role of positive attitudes in determining well-being. Third, we interviewed
older adults living in Taiwan. Although Taiwan is a culturally Chinese society and
has preserved the Chinese heritage in terms of values and family life to a great
extent, it is politically, economically, and psychologically different from mainland
China (PRC; Lu, Cooper, Kao, & Zhou, 2003), thus our results should not be generalized to the vast population of older people in the PRC. Finally, our interviews were
conducted using structured questionnaires. Future studies may consider employing
qualitative methods to explore older people’s attitudes, perceptions and lived experiences of aging in greater depth, so that a fuller and richer understanding of the aging
process can be achieved from older people’s own perspective.
Declaration of Conflicting Interests
The authors declared that they had no conflicts of interests with respect to their
authorship or the publication of this article.
Funding
The author disclosed receipt of the following financial support for the research
and/or authorship of this article: This study was supported by a grant from the
National Science Council, Taiwan, ROC (Grant No. NSC95-2420-H-008-001-KFS).
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Bios
Luo Lu, DPh, University of Oxford, UK, is currently distinguished professor in Department of Business Administration, National Taiwan University, Taiwan. Her major
research interests are culture and self, subjective well-being, stress and adjustment,
work stress and organizational health, and other personality/social/IO psychological
topics. She has been awarded the Distinguished Research Award by the National
Science Council, Taiwan. She has published more than 100 papers in refereed journals, and is the series editor, author, and coauthor of 19 books and 7 book chapters. She
has served in several editorial boards as either associate editor or board member.
Shu-Fang Kao, PhD, National Taiwan University, Taiwan, is currently assistant professor in the Department of Applied Psychology, Hsuan Chuang University, Taiwan.
Her major research interests are work stress, health psychology, work-family conflict,
individual traditionality and modernity, and cultural issues.
Ying-Hui Hsieh, PhD, National Chung-Cheng University, Taiwan, is currently assistant professor in the Department of Human Development, Tzu Chi University,
Taiwan. Her major research interests are social gerontology, women development,
and historical demography.
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